Charge patients for deductibles, copays, and coinsurance amounts

Many offices lose money by not collecting all of the money owed to them from patient responsibilities. Some do it by choice, and others because they don’t have a system for their patient billing. They don’t even realize that the patients are not paying the part due.

In any case, it is important to know that you can get into trouble. With Medicare, it’s illegal not to bill the patient for their portion, whether it’s the deductible or coinsurance. It’s also illegal to bill more than Medicare allows you, so you need to make sure you understand what the patient’s portion is. If Medicare finds out that you are billing Medicare for services, but not billing the patients for the patient’s responsibility, you could be investigated for Medicare fraud.

Of course there are exceptions. If a patient has financial difficulties, you can waive the patient’s responsibility, but you must document this in the patient’s file. And you can’t claim that every Medicare patient you treat is struggling financially. There are also other ways to get around this. You must bill the patient for their responsibility, but there is no law on how far you must go to collect it. So if you send them a patient statement and they don’t pay the bill, there’s nothing saying you have to send a second one. As long as you can prove that you invoiced them.

With commercial insurance, there is usually a clause in the contract you sign that states that you will bill patients for all copays and/or any other patient responsibility. If the insurance company finds that you are not charging the patients, they may consider this a breach of your contract with them and terminate your participation. They usually don’t go beyond that, such as fraud investigations, unless there are other violations as well.

If you have a few patients, friends, relatives, or people with real financial problems that you don’t charge, it probably won’t hurt you. But if you don’t charge your patients pretty much across the board, you could be in trouble. Some people find it difficult to get their patients to pay. These laws are a good excuse for them. “I don’t want to sue you, but if I get caught, I could be removed from the insurance company’s panel or under investigation.”

If you don’t charge your patients, you’ll be surprised how much your receivables can add up if you do. It doesn’t seem like much, but it really adds up.

See also  Deductibles in Depth - Understanding Medical Deductibles

Copyright 2008 – Michele Redmond